Introduction
There’s a type of cyst that develops at the bottom of coccyx or tailbone. It’s called a pilonidal cyst. It can become infected and filled with pus. Once infected, the technical term is “pilonidal abscess,” and it can be painful. It looks like a big pimple at the bottom of the tailbone. It is more common in men than in women. It usually happens more often in younger people. During World War II, more than 80,000 soldiers got pilonidal cysts that put them in the hospital. People thought they were because of irritation from riding in bumpy Jeeps. For a while, the condition was called “Jeep disease.”
People who sit a lot, such as truck drivers, have a higher chance of getting one. They can be treated successfully in most cases. If it is inflamed & painful, it can be drained or taken out surgically.
Signs & symptoms
Pain, redness, tenderness and swelling at the bottom of the spine
Pus or blood draining out of it with bad smell
Fever
Causes
The exact cause of pilonidal cysts is not clearly known. But most pilonidal cysts appear to be caused by loose hairs that penetrate the skin. Friction and pressure — skin rubbing against skin, tight clothing, bicycling, long periods of sitting or similar factors — force the hair down into skin.
Pilonidal means “nest of hair,” and hair follicles are found inside the cyst while removing it surgically. Experts say ingrown hairs are the most common cause of pilonidal cyst.
Another theory is that pilonidal cysts appear after a trauma to that region of your body.
A small dimple in the skin between buttocks at birth can be a risk factor for developing pilonidal cyst later in life.
Other risk factors include obesity, long & thick hair, sedentary lifestyle, prolonged sitting, and excessive sweating.
Pathophysiology
It has been postulated that hair penetrates into the subcutaneous tissues through dilated hair follicles, which is thought to occur particularly in late adolescence, though follicles are not found in the walls of cysts. Upon sitting or bending, hair follicles can break and open a pit. Debris may collect in this pit, followed by development of a sinus with a short tract, with a not clearly understood suction mechanism involving local anatomy, eventually leading to further penetration of the hair into the subcutaneous tissue. This sinus tends to extend cephalad, likely owing to mechanical forces involved in sitting or bending. A foreign body-type reaction may then lead to formation of an abscess. If given the opportunity to drain spontaneously, this may act as a portal of further invasion and eventually formation of a foreign body granuloma. Infection may result in abscess formation.
Microscopically, the sinus where the hair enters is lined with stratified squamous epithelium with slight cornification. Additional sinuses are frequent. Cyst cavities are lined with chronic granulation tissue and may contain hair, epithelial debris, and young granulation tissue. Cutaneous appendages are not seen in the wall of cysts, meaning the cysts lack epithelial lining, unlike the sinus. Cellular infiltration consists of lymphocytes, and plasma cells in varying proportions. Foreign body giant cells in association with dead hairs are a frequent finding.
Diagnosis
In most of the cases, physical examination with detailed history can confirm the diagnosis
In rare cases, imaging techniques like USG, MRI etc. will be required.
Treatments
Antibiotics do not heal a pilonidal cyst. But there are therapeutic procedures including:
Incision and drainage: This is the preferred method for a first pilonidal cyst. Making a cut into the cyst and draining it. Then any hair follicles are removed and leaves the wound open, packing the space with gauze.
Marsupialization: In this procedure, A cut is made and pus is drained. After removing pus and any hair that are inside, the doctor will sew the edges of the cut to the wound edges to make a pouch.
Incision, drainage, closing of wound: In this technique, the cyst is drained, but it’s not left open.
It is important to obey all instructions by doctor, after a surgery.
Try to keep the area clean. Check for any signs of a new infection, such as redness, pus, or pain.
Continue regular follow ups to ensure the healing of the cyst.
Prognosis
A complete cure is possible in most of surgically removed pilonidal cysts, but chance of recurrence is high.
Complications
Abscess formation.
Recurrence of the pilonidal cyst.
Systemic infection (infection that spreads throughout the body)
Rarely, squamous cell carcinoma, a form of skin cancer
Disease & Ayurveda
Naadeevrana(sallyaja)
Nidana
Asaadhuvrtha – inadequate drainage of sopha(swelling) or pooya(pus)
Purvaaroopa
Not mentioned
Samprapti
When the foreign body causes inflammation & swelling a cyst like sopha forms. In cases where this sopha is not incised& drained properly, the inflammation spreads into deeper tissues in the form of a tunnel and develops the naadeevrana.
Lakshana
One open wound on the skin outside the body
Pain & swelling, pain will be continuous & severe
Reddish,blackish discolouration may be present
Continuous and sero-sanguineous pus discharge from the open side
Fever and other systemic signs of inflammation will be present in acute infections.
Divisions
Vatika
Paittika
Kaphaja
Thridoshaja
Sallyaja/aaganthu (due to the presence of a foreign body)
Prognosis
Kricchrasadhya
Chikithsa
When nadeevrana is formed due to a foreign body, it should be extracted surgically. Once the foreign body is completely removed and the pus is drained out completely, the treatment for wound healing should be done. Symptomatic management for pain relief should be done along with main treatment.
Samana
Upanaaha – bandage to prepare the area for extraction of sallya inside
Poorana – filling up the naadee with herbs
Bandhana – bandage of the clear wound after the surgery
Kshaalana – washing the area with wound healing medicines
Sodhana
Paatanam/Chedanam/Vidaaranam – surgical removal of foreign body
Sallyanirharanam – extraction of sallya
Margapravisodhanam – drainage pus and residual tissue
Then treatment of wound should be done
Commonly used medicines
Varanadi kashayam
Dusparsakadi Kashayam
Dasamulakaduthryam Kashayam
Kankayana Vati
Chiruvilwadi kashayam
Guggulupanchapalachoornam
Kanchanaraguggulu
Nalpamaradi kashayam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Sit bath or soak the area in a tub of warm water
Take OTC pain relievers
Keep the cyst and area around it clean and dry
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Protect yourself from hot climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Avoid continuous sitting and squatting.
Avoid constipation.
Yoga
Exercises are completely restricted in cases of a severe infection. In mild cases or after surgery & follow up, regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/10950015/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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